'When you hear hoofbeats, think of horses not zebras' - the old adage is well-known to GPs but what should you do when faced with a zebra, not a horse? Consultant cardiologist Professor Robert Tulloh and GP Dr Louise Tulloh kick off our new series with their advice on how to catch Kawasaki disease in general practice.

Threat to dispensing practices after 9% cut in fees

Dispensing practices could face closure as a result of a surprise 9% cut in their dispensing fees from next month, GP leaders have warned.

The average dispensing fee per item will fall from £2.14 to £1.95 from October, leading to a reduction in the average dispensing practice's income of £853 per month.

Dispensing practices also face a Government 'cost of service inquiry' into the funding of their services from early 2010.

The development comes less than a year after dispensing doctors were given a reprieve on rule changes that threatened to remove the right to dispense from surgeries that were too close to pharmacies.

GP leaders have warned the cut in fees represents a similar threat to viability of practices, and combined with rising drug prices from wholesalers, threatens the services dispensing practices provide.

From 1 October the fee scale for dispensing doctors will be lowered by 8.7 per cent for the remaining six months of the financial year, representing a 4.9 per cent decrease across the whole year.

Dr David Bailey, lead negotiator on dispensing for the GPC, said the GPC was ‘disappointed' at the cut in funding.

‘Many patients in rural areas rely on dispensing practices to obtain their medicine and I am very concerned that NHS Employers has underestimated the costs of providing dispensing services, which inevitably rise with increasing volume,' he said.

‘The "cost of service inquiry" should help develop a fairer cost analysis and reimbursement structure in future, but the Government needs to act urgently to deal with the unilateral withdrawal of discounts by many of the drug wholesalers, which could threaten the viability of some dispensing practices.'

The Dispensing Doctors Association says the fee cut would have a ‘serious effect' on the profits of practices and may lead to dispensing services being cut.

Dr David Baker, chief executive of the DDA, said: ‘When pharmacy was in this position last year, the PSNC was able to negotiate some emergency funding to prevent their businesses going to the wall.'

‘Unless something similar is put in place for dispensing practices, the combination of fee reduction and reimbursement at a loss could make doctor dispensing a non-viable activity,' he said.

A 9% cut in fees could force some dispensing practices to close, GPs have claimed A 9% cut in fees could force dispensing practices to close, GPs have claimed